A Randomized Controlled Trial of a Discharge Nursing Intervention to Promote Self-Regulation of Care for Early Discharge Interventional Cardiology Patients
This randomized controlled trial (RCT) examined a discharge nursing intervention (DNI) aimed at promoting self-regulation of care for early discharge interventional cardiology patients. The purpose of this study was to compare medication adherence, patient satisfaction, use of urgent care, and illness perception in patients with cardiovascular disease (CVD) undergoing interventional revascularization procedures who receive usual care and those who receive a DNI. The Common Sense Model (CSM) of illness representation provided the theoretical foundation for this study. The CSM is a cognitive parallel processing model that draws relationships between illness representation, coping methods, and illness outcomes to help explain the process by which people make sense of their illness. Intervention research aimed at life style changes to reduce secondary events after treatment for CVD is needed to guide evidence based care. Treatment for CVD has shifted from surgical repair with prolonged hospitalizations to interventional procedures requiring shorter hospital stays. This trend reduces nursing time to monitor complications and provide education about medication management and lifestyle changes. Patients recover in short stay areas and return home within hours or one to two days of the procedure. Cardiac disease is then managed as a chronic, but often stable condition. With this change in the delivery of care, several trends have emerged that have implications for quality nursing care and patient outcomes: a) the burden of care shifts from the hospital setting to home, b) patients are discharged without extensive education about complications and disease management, c) the occurrence of secondary events and disease progression remain a valid threat, and d) nurses with expert practice are in a unique position to assist patients and families with CVD management. This study addressed the following questions. 1. Do patients receiving the nursing intervention differ significantly from those receiving usual care on medication adherence? 2. Do patients receiving the nursing intervention differ significantly from those receiving usual care on patient satisfaction? 3. Is there a significant difference in the utilization of urgent care between those patients receiving the nursing intervention when compared to those patients receiving usual care? 4. Does a difference exist between the patients receiving the nursing intervention and those patients receiving usual care on illness perception, as measured by seven components of the IPQ-R: time line (acute and chronic), consequence, personal control, treatment (cure) control, illness coherence, timeline (cyclical), and emotional representations? Purposive sampling was used to select a sample of patients admitted for interventional procedures at an academic teaching hospital. One hundred and fifty four patients were and randomized into control and experimental groups. Final analyses included data from 129 patients. Sixty-four participants in the experimental group received the DNI which included: 1) additional written information about taking medications, 2) a medication pocket card, 3) a list of 3 cardiac internet sites,and 4) a phone call, 24 hours post procedure, from an expert cardiac nurse to review discharge instructions. Sixty-five participants in the control group received usual care. Analyses on four outcome measures, medication adherence, use of urgent care, patient satisfaction, and illness perception, revealed one statistically significant result. Participants in the experimental group, receiving the DNI, scored significantly higher than the control group on one measure, the timeline (acute/chronic) component of illness perception (p = .006) indicating a greater appreciation of the chronicity of their disease. Otherwise, there were no significant group differences found. This study provides support for nursing intervention research guided by self-regulation theory that examines the patient's perception of illness. Patients with cardiac disease who received the DNI were statistically more likely to acknowledge that their illness would last a long time. This awareness, may improve adherence to a prescribed regimen of medication and lifestyle modification. Nursing interventions guided by an understanding of patients' belief that their cardiovascular disease is chronic will add to the body of knowledge that informs providers about decisions patients make concerning medication adherence and lifestyle modifications. However, the results underscore the limitations of adding additional discharge care to this population of patients to improve medication adherence, use of urgent care, and patient satisfaction. Future research should include a longitudinal study to examine how patients who perceive their disease to be chronic in nature managed their medications and care decisions at home.